Provider Demographics
NPI:1376667584
Name:GAMBLE, DEIRDRE DENISE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:DENISE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13535 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3029
Mailing Address - Country:US
Mailing Address - Phone:313-255-8887
Mailing Address - Fax:
Practice Address - Street 1:3737 LAWTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2500
Practice Address - Country:US
Practice Address - Phone:313-361-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010710051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical